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Instructor Name *

List Full Name

Email address *

Student First Name *

Student Last Name *

Course Name *

Please rate the following aspects of the student-athlete's success in your classroom

Attendance *

ExcellentGoodFairPoor

Participation/Preparation *

ExcellentGoodFairPoor

Assignments/Homework *

ExcellentGoodFairPoorN/A

Test Scores *

ExcellentGoodFairPoorN/A

Quizzes *

ExcellentGoodFairPoorN/A

Labs (If applicable) *

ExcellentGoodFairPoorN/A

Writing *

ExcellentGoodFairPoorN/A

At this time the student-athlete's approximate grade *

ABCC-DD-F

Approximate percent of grade completed at this time:

Should the student-athlete make an appointment to discuss withdrawing from your class? *

I understand that Academic Affairs prohibits coaches from contacting faculty, unless the faculty member gives permission. By selecting yes, I am granting permission for the coach to contact me via email to discuss this student-athlete, if needed. *

Please provide any additional advice, comments or feedback that can help the student-athlete achieve a better overall level of performance in your class